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Usability of a Mobile Health Application in Older HIV-Infected Patients: An Emerging Tool for Care, Education
and Prevention
Jordi Puig Pla, RN
Fundació Lluita Contra la Sida. Germans Trias University Hospital. Badalona,Spain
Background Objectives Methods
• HIV is becoming a complex chronic disease associated with numerous
medical, psychological and social problems, which requires the attention
and experience of a wide range of health specialists
• In 2015, about 50% of HIV-infected patients had more than 50 years
• Increase in the cost of HIV care associated with aging:
• More expensive ART (more complex regimes)
• More comorbidities
• Concomitant medication interactions
• Adherence problems
DiscussionResults
• The development of mobile devices has growing in the health field
• This technology could influence the prevention or treatment of patients
with chronic disease (diabetes, HTA, etc ...)
• Information and communication technologies are a new strategic
element to improve the health of citizens and ensure a quality, modern
and sustainable health system.
• APPs in health can help in greater involvement and co-responsibility of
users through self-care and self-management of health.
Background Objectives Methods DiscussionResults
Background Objectives Methods
1) Previously the clinical trial: To determine the interest of our patients
with respect to a medical APP as well as the sections of interest to
monitor their health using a self-report 8-item survey
2) To determine the usability of a specific APP among HIV-infected
patients aged 60 years or older at week 24 and a final analysis at
week 48 was repeated to determine the usability at the end of the
study.
DiscussionResults
Secondary objectives
1) To compare the number of presently visits to the HIV Unit over the
study period between both groups (APP vs controls);
2) To compare the patients’ satisfaction in the APP group assessed by a
test ad hoc ranging from 1 (worst) to 5 (best) between baseline and
week 48;
3) To compare between both groups the quality of life at week 48 by a
test of life, SERAD, patients adherence by an adherence test, MOS
and some clinical parameters.
Background Objectives Methods DiscussionResults
Background Objectives Methods
Design:
A prospective, randomized, case-control, 48-week, pilot study was
conducted in HIV-infected population aged 60 years or older, to assess
the usability of a specific APP for these population and changes in
their satisfaction and quality of life.
Subjects:
One hundred patients were randomized to:
- APP group: APP+routine medical controls (N:50) or
- Control group: routine medical controls (N:50).
DiscussionResults
Background Objectives Methods
• Inclusion Criteria:
o Patient aged 60 years or older infected with HIV in antiretroviral treatment.
o Experience to the use Smartphone.
o Commitment to regular monitoring of scheduled visits.
o Acceptance and signature of informed consent.
o Exclusion Criteria:
o Patients with pathology that hinders the understanding and use of mobile
applications were excluded.
DiscussionResults
Background Objectives Methods DiscussionResults
Parameter Baseline visit24 week
follow-up
48 week
follow-up
Informed consent (IC) X
Randomization XA
Training App XA
Physical examination X X
DXA scan XB X
Laboratory test X X
Viral Load X X
CD4/CD8 t-cell count X X
HCV serology XC X
HBV serology XC X
Syphilis (VDRL test) X X
Quality of life test (MOS-HIV test)
X X
Satisfaction test (Likert scale) X X
Interim questionnaire XD
Adverse Events X X
Comorbidities X X
Concomitant medication X X
Adherence to ART (SMAQ questionnaire)
X X
Background Objectives Methods DiscussionResults
Health Center
iOS and Android
Patients
Backoffice from web browser
Background Objectives Methods DiscussionResults
Apointments: Scheduled visits, changes, cancelations
Background Objectives Methods DiscussionResults
Communication with health center
PUSH
Notifications
SMS
Video calls
Ceter Pacient
Total APP Control
Age(Years;IQR) 65 (63-69) 66(63-69) 64 (62-70)
Sex (% Male) 39 (78%) 43 (86%)
HIV History (Years) 21(16-25) 23(18-26) 20 (15-25)
Total ART Time (Years) 19 (13-23) 21 (13-23) 18 (13-23)
Actual ART Time (Years) 1.2(0.4-2.6) 1.3(0.3-3.1) 1.0 (0.6-2.4)
Actual ART(%)
PI 24% 23% 26%
NUNC 2% 3% 4%
INI 38% 39% 37%
Other 36% 35% 33%
Risk Group (%)
MSM 46% 52% 40%
HSM 25% 18% 32%
Drug users 9% 8% 10%
Hepatitis C positive (%) 12 (12%) 4 (8%) 8 (16%)
Undetectable HIV-1 RNA
(Cops per ml)
94 (96%) 48(96%) 47(94%)
CD4 count (cells per ml)
Median (IQR) 562 (422-746) 596(472-782) 536(380-696)
<200 3(3%) 2(4%) 1(2%)
• In the APP group, the percentage of patients who used the APP increased from
52.2% at week 24 to 73.8% at week 48 after a weekly reminder, as well as the
different days that patients used the APP (from 14.2 to 23.7).
• The most visualized screens were health counseling educational
recommendations and medical record [24.8% and 22.2% respectively].
• Patients aged from 60 to 65 years old were the patients that most actively used
the APP (P=0.029).
Background Objectives DiscussionResultsMethods
• At week 48, 85.2% of patients thought that the APP was useful and 91.4% of
patients would recommend the APP to other friends or relatives.
• The APP was well valuated by participants [4.79 (±0.41) out of 5.00] and 64.6%
thought that the APP improved their health attention.
• The number of presently visits in the HIV unit over the study were significative
lower in the APP group (4.29 to 5.33 p=0.03).
• There were no significant changes in patient’s quality of life, adherence and
clinical parameters recorded.
Background Objectives DiscussionResultsMethods
Background Objectives DiscusionMethods Results
• Our study shows a low usability of the APP among this population (mainly among
those aged over 65 years old), that increased a weekly reminders suggesting that
an appropriate training would increase their use.
• It is therefore necessary to promote the knowledge and motivation of this age
group about the mobile applications since this is a target group for using new
strategies to better manage them. Meanwhile, young HIV-infected people could
take advantage of these applications.
• The m-health will be a basic element for monitoring chronic diseases. A large
proportion of adults, especially those who are older than 65, have a chronic
pathology that requires a closer attention. When the percentage of older people
who handle APP rises, a solid and proven strategy for use should already be
established.